On Cancer: Are Electronic Cigarettes Safer to Use than Conventional Cigarettes?

Electronic cigarettes are battery-powered vaporizers that deliver nicotine and other additives in an aerosol format. An LED light at the tip simulates burning tobacco.

Update: On April 24, 2014, the US Food and Drug Administration proposed new rulesthat would expand its regulatory authority to include electronic cigarettes. As reported in The New York Times, the regulations would ban the sale of e-cigarettes, cigars, and pipe tobacco to Americans under 18, and would require that people buying them show photo identification to prove their age. Below is a post that addresses the FDA’s concerns on the safety of e-cigarettes, featuring assistant director of Memorial Sloan Kettering’s Tobacco Treatment Program, Jack E. Burkhalter. Stay tuned to our blog for updates on Memorial Sloan Kettering’s latest research on e-cigarettes.

Many smokers around the world are choosing electronic cigarettes (also known as e-cigarettes) in the belief that they are less damaging to their health. Millions of Americans have joined the trend since the tobacco-free devices were introduced domestically in 2007, with sales estimated to reach $1 billion this year.

Although they differ in shape and size, e-cigarettes basically all function in the same way. The user inhales through a mouthpiece, triggering a sensor that turns on a battery-powered heater. This action vaporizes liquid nicotine and activates a light at the tip.

The heater also vaporizes substances such as propylene glycol and glycerol to produce theatrical smoke similar to the white puff produced when exhaling tobacco cigarettes. Flavorings such as mint, chocolate, and bubblegum are often added.

Among the new users are many young people. The number that have tried e-cigarettes doubled from 2011 to 2012, according to the Centers for Disease Control, which estimates that a total of 1.78 million middle and high school children have experimented with the devices.

Many Unknowns

Dr. Burkhalter says he often hears smokers claim e-cigarettes must be healthier than conventional cigarettes because they do not contain tobacco. But e-cigarettes do contain a liquid form of nicotine, a highly addictive tobacco component that may cause changes in the developing brains of young people. And the consequences of long-term nicotine use in adults have not even been fully studied, Dr. Burkhalter explains.

“Another problem is that we have no way of knowing what’s in a given product,” Dr. Burkhalter says, as manufacturers and types of e-cigarettes vary widely. “There is no one product — so it is impossible to determine whether any given e-cigarette is in fact safer than a conventional one, or safer than another brand of e-cigarette.”

Most electronic cigarettes sold in the United States are imported from China, which does not regulate or standardize the products. Domestic e-cigarettes are not government regulated, either. As a result, users are left in the dark regarding how much nicotine or other substances they are inhaling.

What those other substances might be is yet to be determined. While more research on the topic is needed, some studies indicate that e-cigarettes may contain a variety of chemicals, from suspected carcinogens to heavy metals and airway irritants.

Nor has much research been done to determine the health impact of inhaling e-cigarette vapors into the lungs.

“So while they may seem to be safer compared to tobacco cigarettes because they don’t contain tobacco and tobacco smoke, we can’t really quantify if that is the case,” Dr. Burkhalter says. “Overall, I hope for the best—but fear the worst.”

Questions of Safety to Others, and to Youth

“I hope for the best but fear the worst. The issue of whether e-cigarettes are safe and actually help smokers quit is a problem we will have to grapple with until we have more evidence.”

-Jack Burkhalter, Assistant Director, Tobacco Treatment Program

The health risks of secondhand exposure to tobacco smoke are well established. Still unclear, however, is the impact of secondhand vapor from e-cigarettes, Dr. Burkhalter says. “E-cigarette users may feel more at ease in smoking around others, including children — a decision based on their perception of reduced harm. Unfortunately, this perception isn’t supported with sound scientific data.”

He also finds the rising numbers of young people trying electronic cigarettes very concerning because the devices might serve as gateway products to tobacco use. According to the CDC report, of the nearly 1.8 million middle and high school children who have tried e-cigarettes, an estimated 160,000 of them have never used conventional cigarettes.

Any exposure to nicotine can have harmful effects on the development of the body and brain in a young person, Dr. Burkhalter notes.

Regulators and Options for People Trying to Quit

“E-cigarettes have an allure, and it’s difficult at times to convince people that instead of turning to products that we still don’t know a lot about, we have evidence-based ones that, unlike the e-cigarette, have been approved by the Food and Drug Administration and have proven track records for enabling many people to break their addition to nicotine,” Dr. Burkhalter explains.

In addition to nicotine replacement products such as chewing gum, lozenges, and skin patches designed to ease cravings, there is the nicotine inhalation system (such as the Nicotrol® Inhaler) — which he says is the closest in look and feel to the e-cigarette.

But what this prescription-only product doesn’t have is the benefit of styling in appealing shapes and colors, or the illusion, complete with visible vapor puffs, of smoking a cigarette. “Many of my patients won’t be seen with the Nicotrol Inhaler; marketing of the Food and Drug Administration–approved cessation products has not been as sophisticated and aggressive as those for e-cigarettes,” Dr. Burkhalter says.

What these FDA-approved nicotine replacement products do provide is definitive information about their ingredients, including how much nicotine they deliver. They represent tools to use along what is known as the “harm-reduction continuum,” with total abstinence on one end of the spectrum, the use of conventional tobacco cigarettes on the other, and products that offer less damaging alternatives at various points along the middle.

“If the FDA decides that it will start regulating the e-cigarette industry – a ruling on this is expected in the fall of 2013 – we will soon learn a lot more about what is contained in these devices and where they might fit along this harm-reduction continuum,” Dr. Burkhalter explains. Many countries with tobacco control policies are struggling to shape policies regarding safety and the appropriate use of e-cigarettes.

Meanwhile, research about e-cigarette use is under way at Memorial Sloan Kettering and elsewhere to take stock of how cancer patients use e-cigarettes, whether users are more likely to quit smoking tobacco cigarettes, what sorts of substances the products contain, and what the health risks of inhaling vaporized chemicals might be.

Comments

Submitted by Alan Silberberg | Thursday, October 31, 2013 - 3:55 PM.

I find it interesting that you think the deleterious health effects of second-hand smoke are "well established." I assume you are a scientist as well as a physician. If so, do you think the EPA report on second-hand smoke was capably done? Thirty one studies which had to not only be combined in a meta-analysis to show a statistical effect (at the 0.1 level, by the way), but also had to be scaled in terms of quality by EPA prior to data aggregation. The largest study of them all, Garfinkel's study of second hand smoke among a million people found no effect. Furthermore, cigar and pipe smokers are obviously heavy second-hand smokers. Yet the original Surgeon General's report recommended cigarette smokers switch to pipes and cigars because their data (those in the Surgeon General's report) showed that pipe and cigar smokers have the same mortality rate as non-smokers.

Alan, according to Dr. Burkhalter, the statement is supported by findings of the Surgeon General’s Report on Health Consequences of Involuntary Exposure to Tobacco Smoke published in 2004, and subsequent research since then, which found secondhand smoke causes premature death and disease in children and in adults who do not smoke. Thank you for your comment.

Submitted by Richard Hanlon | Friday, November 1, 2013 - 11:24 AM.

Been cigarette free since March 2013. Have had head and neck cancer(tonsils and lymph nodes)in 2008-cured. Have had prostate cancer since Dec.20012, in remission.Urologist told me smokers are prone to bladder cancer so I quit smoking and took up E-cigarettes. Feeling better but only hope what I'm doing with the electronic cigarettes are safe to a degree.

Submitted by Morgan | Friday, November 1, 2013 - 4:57 PM.

E-cigarettes are handy at public functions, but I don't kid myself that they are "healthy" or even a good way to quit smoking.

It's up to each person to make their own health decisions, and helping them with those decisions is important. It seems the best thing about E-ciggs is there is, I suspect, no second hand smoke to injure others. A step in the right direction.

Submitted by Steve W | Thursday, December 26, 2013 - 6:45 PM.

Every time I want to light up, I just eat a bag of potato chips instead...

Submitted by Carl Horton | Saturday, February 15, 2014 - 7:25 AM.

I quit smoking 3 months ago and have been smoking a vapouriser ever since and I have never felt healthier (aopart from before I started smoking in the first place, obviously) I don't get out of breath climbing stairs, my clothes and breath don't smell, I've lost the morning hacking and coughing session (don't miss that one bit) Anything doing this much good can't be a bad thing.
@ Hamza, the article isn't "exposing" anything, it is hypothesising, there is no scientific evidence to vindicate any claims that these devices are detremental to health !!

Submitted by Anonymous | Monday, March 3, 2014 - 11:22 PM.

U have no idea how popular vapes are in
Middle school these days.

Submitted by ashley meier | Thursday, March 13, 2014 - 2:05 AM.

I took on smoking when I was 14 and never quit. I got pregnant at 18 and still didnt quit I was smoking a pack 1/2 a day. I took on smoking cause of stress. Now 22 pregnant with my second. And decided to quit for the pregnancy. So I starting vaping 2 months ago. And havent had a cigarette since. I never felt healthier. Vaping was the best decision I ever made.

Submitted by tony Montana | Friday, April 4, 2014 - 7:51 AM.

Thats all i here people complaining about kids smoking e cigs well i remember when i was i middle school and you'll be surprised of the actual real amount of kids that smoke (the ones that dont tell no one) you statistics o.ly show the ones the admit to it not a real number at all. At least e cigs are a lil better and a lil goes a long way the kids gonna try stuff and smoke anyways at least there trying something less harmfull any way you put it e cig are less harmful than real cigs and thays what we trying to accomplish here y'all just looking for a problem when theres non evident i can speak for myself and they have saved my life no more coughing all day no more smokey clothes its a good thing and y'all trying to ruin it. Let it go

Submitted by Reta Lane | Monday, April 28, 2014 - 5:54 AM.

I was conversing with a doctor that was doing research on the affects of e-cigarettes and he said there wasn't any harmful affects.

Reta, thank you for your comment. As Dr. Burkhalter explains in the story, e-cigarettes do contain a liquid form of nicotine, a highly addictive tobacco component that may cause changes in the developing brains of young people. And the consequences of long-term nicotine use in adults have not even been fully studied. While e-cigarettes may seem to be safer compared to tobacco cigarettes because they don’t contain tobacco and tobacco smoke, we can’t really quantify if that is the case.

Submitted by James O'Donnell | Wednesday, April 30, 2014 - 5:49 PM.

First off, I want to thank Sloan-Kettering for saving my life. I had stage IV Espohageal cancer back in 2003-2004 and have been in remission for 10 years now, thanks to their fine establishment. I am 48 now and starting smoking at the age of 17 and on average, I smoked approximately 1 pack per day.

On January 1 of this year, I began using Nicoderm patches and began smoking e-cigarettes. Since I failed at many attempts to quit before, I conducted months of planning prior to quitting conventional cigarettes and to this date, I haven't touched a cigarette since. This is also the first time I actually completed the Nicoderm step down process.

Obviously, I am fairly new to vaping but I do know that the liquid I purchase is manufactured in the United States and it does contain nicotine. I usually purchase a nicotine lever of 1.8%, which is equivalent to a light cigarette. I also enjoy a small array of flavors from traditional tobacco to vanilla to coffee.

Yes, we can only hope that e-cigarettes are healthier than traditional but after reading much about them, I believe they are, considering they don't contain many of the harmful substances of a regular cigarette. The best part is I haven't touched, nor wanted a regular cigarette since. I look at it as a trade off, hoping the e-cigarette is indeed the safer if the two.

I have met with Dr. Burkhalter during my time at Sloan-Kettering and he is not only a great Physician, but a fine, intelligent and understanding man. If you ever need a volunteer for study, please let me know. I would be more than happy to assist in any way that I can.

Submitted by Bruce | Thursday, May 1, 2014 - 1:53 PM.

This article is practically devoid of facts, and merely spreads anxiety using verbs like "may." Why mention that nicotine "may" affect the development of young brains or that it "may" effect long-term users? Substitute the phrase "cell phone" for this and you'll see it's just as theoretical. But Dr. Burkhalter leaves out some actual facts that don't have to use the verb "may." Cigarette smoking involves combustion, e-cigarettes don't. Kind of an important fact for this discussion, isn't it? Furthermore, there are also small amounts of nicotine carcinogens in all the conventional quit-smoking products, from chewing gum to patches. One study I read found considerably less of these substances in e-cigs. This anxiety-sowing reminds me of the abstinence promoters in the early days of AIDS (it's the only "sure" way of avoiding the disease), as well as those who opposed needle exchange. When there is a promising harm-reduction technique, why begin with doubts about it? Isn't it better to doubt that cigarette smoke, with its 2,000 carcinogens produced by combustion, is more dangerous than something that produces nicotine delivery by non-combustion? And take it from there.

Submitted by Bruce | Thursday, May 1, 2014 - 1:55 PM.

Sorry, the second to last sentence said the opposite of what I intended. I meant to say: "Isn't it better to doubt that cigarette smoke, with its 2,000 carcinogens produced by combustion, isn't more dangerous than something that produces nicotine delivery by non-combustion?

Submitted by Hamzahafeez | Saturday, May 3, 2014 - 7:32 AM.

I cant understand that e cigratte is better than other tabacco cigerrate. Kindly reply me. Thanks

Hamazahafeez, according to the article, "some studies indicate that e-cigarettes may contain a variety of
chemicals, from suspected carcinogens to heavy metals and airway Irritant." In addition, "There is no one product so it is impossible to determine whether any given e-cigarette is in fact safer than a conventional one, or safer than another brand of e-cigarette." Thank you for your comment.

Submitted by Jodi | Monday, May 5, 2014 - 11:32 AM.

I starting somking when I was 8. I have smoked between a pack to a pack and a half a day since then. I am now 51. I have Sjogren's, Rheumatoid Arthritis and COPD. My doctors have been begging me to quit for at least 15 years. A friend of mine quit smoking using the Logic E-Cig. So I decided to give it a shot, not thinking that it would work. I have done the patch, the gum, the pill, hypnotism, and accupuncture. Nothing worked. To my amazement the Logic E-Cig had me quitting. I started using it on a Friday and by Tuesday I was smoke free. The longest I had ever not smoked since I started was 24 hours and I did that one time. I am now ciggarette free for 2 months. Myself, my doctor's and my family are shocked to say the least. I plan of weaning myself off the E-Cig by December 2014 but I am not going to rush it. I don't ever want to go back to smoking again. I have been cough free for over a month and I no longer wheeze. I have more energy thant I have had in years. The E-cig does irritate my throat at times but this is better than the alternative of smoking. I think for people that tried all other methods to quit smoking the E-cig is a viable option. Is there stuff in there that could potentially be harmful, probably but less harmful than continuing to smoke. I think there should be an age limit to purchase the E-Cig just like with ciggarettes. I also think that adults need to be more responsible and not leave liquid nicotine laying around where young children have exposure to it. So I am on the fence. Like I said I am sure there is stuff inthe E-Cig that isn't good for you but again better than actually smoking a pack an a half of ciggarettes.

Submitted by Andrea M | Saturday, May 31, 2014 - 10:14 PM.

I find it ironic that all these "government" and "medical" studies always write negative articles in regards to e-cigs. There are more then 32 carcinagens in cigarettes but they still don't want to make them illegal. Obviously not smoking at all is the best solution, but for those that struggle with the nicotine addiction e-cigs are the best way to go. I am an ex-smoker that was lucky enough to quit without the aid of any nicotine replacement therapy but I have watched my spouse fall off the wagon numerous times. As he approaches 50 and his many years of smoking has taken a toll on his health, I welcome the option of him being able to try something else that actually works without all the poisons that go along with regular ciggarettes. So Yay for advanced technology that has given many of us the option to go with something much healthier and hopefully will keep my spouse around for many years to come.

Submitted by Francesca | Saturday, July 12, 2014 - 4:55 AM.

I am happy about the health benefits for the user but now my husband thinks it OK to vap inside the house -he never smoked inside the house. I find that the caps make me nauseous.

Submitted by C Faughn | Saturday, August 9, 2014 - 3:28 PM.

Thank you for the thoughtful article. I would like to add our experience with the E-Cig and the importance of having a plan before using one. My Husband and I are very long time smokers up to thirty years and have tried every prescription and device available to try to quit smoking. We were unsuccessful in qwuitting long term until we bought our first E-Cigs on -line 6 months ago. We were impressed with the idea of nicotine in the e-liquid is made with different strengths. Once we found an E-juice flavor we enjoyed (French Apple Cinnamon Pie) we stayed with the flavor but slowly lowered the nicotine levels of the E-Juice over 6 months. I am down to zero nicotine in my E-Juice and rarely use it anymore as I have successfully removed all nicotine from my body and its cravings. Because I can still get the sensation of smoking and the exhalation of vapor as smoke; if a craving hits me I can use my E-Cig without harm. Thank you CM Faughn, thirty year smoker.

Submitted by jose | Tuesday, September 23, 2014 - 6:20 PM.

So the doctor recomends real cigarettes as a less risky option to the e-cigarette? Or he is just predicting the result and the politicaly correct behaviour of the researchers engadged in the investigation? I think the ethical behaviour requires at least to wait the result of the invertigation in progress. I don't think that any brand of USA cigarettes, although very strictly regulated, produce safer cigarettes than most of the e-cigarettes.

Submitted by Zephon Rae | Wednesday, October 1, 2014 - 4:44 PM.

Only crappy parents who would die rather than admit any liability in their children's lives, bray about e-cigarettes being used by minors as a reason to ban it. Kids will explore, sometimes kids will do anything to feel different or look cool. I would know, I was one, once. Parents need to step up their involvement and not pass the buck. Schools need to crack down on paraphanelia, not expelling kids for drawing a picture of a gun, or playing with nerf guns in their own yard. Do your studies, please, we'd all love to know. But vaporizers halted my mothers hacking cough, and doesn't aggravate my grandmother's COPD. Why is that? Why isn't my mother and stepdad sick all the time anymore, since they quit cigarettes and started vaping? How can that "second-hand" vaporizer smoke not make my grandmother cough and choke while the slightest cigarette smoke will? Banning these products in favor of cigarettes is the single most evil thing one can do.

Submitted by Crystal | Thursday, November 6, 2014 - 10:15 PM.

I would just like to say... As an Australian, smoking has become ludicrously expensive. My partner and we want to quit but are not quite ready. We decided to try e cigs. Firstly I'm under no illusion one is better than the other, however, instead of spending nearly $900 a month I'm now spending $150. Also I'm not wheezy in the morning or coughing up gunk every other hour. I think the doctors are just doing their job, if they don't know the long term effects then they can't possibly recommend it. If you are like me and stupid enough to smoke in the first place... What have you got to lose?

Submitted by angela | Friday, December 5, 2014 - 5:07 PM.

What we all need to do is have our doctors do bosworth and keep doing tests periodically to see if lungs and other stuff improve. My friends doctor did it and his improved.

Submitted by Tee | Sunday, January 4, 2015 - 3:58 PM.

To address several things I noticed in the article - no scientist goes out and DEFINITIVELY states something. Words like "may" and "can possibly" are used because that's the way we are taught to write scientific articles. For example, cigarettes "may lead" to cancer, because not in all cases, do cigarette users HAVE cancer, but a statistical significant bunch of them (i.e. way outside simple luck, or sampling error) do have cancer. And with more than a thousand studies pointing to cigarettes leading to cancer, you can then go ahead that say that the studies conclusively state that cigarettes may lead to cancer. However, there's barely any research on e-cigarettes, given it's only been available since 2007, long term longitudinal studies (long-term studies) can't be available, because they require funding, and require wide-scale application. If only 1% of tobacco users are using e-cigarettes, the application of your findings only applies to that 1% so it's very hard to get funding for a research study which applies to so little of a population. So it's impossible for a sound scientist to go out there and conclusively state that e-cigarettes are safer, because the research isn't there yet. But the research is there on nicotine, and a sound scientist can reach a logical conclusion that e-cigarettes that contain nicotine "may cause changes in the developing brains of young people."

Submitted by James Boone | Monday, January 12, 2015 - 6:54 PM.

I turned 27 recently and I have smoked since I was 12. I didn't start using tobacco habitually until I was 15 or so and smoked at least a pack a day so I've been at it for 12 years. I've tried to quit many times and always found myself resorting back to cigarettes. A month and a half ago I decided to try vaping in the hopes that it would get me off the cigs and of course feeling healthier. Since I started vaping I have noticed much improvement in my lung functions and I have not had the desire to smoke a cig which blew my mind away. Now the question is who actually knows anything g about these ecigs!? I feel healthier but after researching ecigs no one can give me any hard factual information. If any docs ever do a study group sign me up because I want to know.

Submitted by Mike Bain | Wednesday, February 4, 2015 - 12:39 PM.

Apparently the American Thoracic Society has their own agenda.
Please feel free to go to sfata's webpage, and follow the link on the bottom of the page, under Ecig News.
sorry i cannot post the exact links here, there seems to be a "spam" filter.

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